Sample Nurse Aide Training Program Lab & Clinical Skills Checklist NAME OF STUDENT NURSE AIDE:_________________________________________ LAB INSTRUCTION: Instructor to initial & date each practical skill once the student has performed a satisfactory return demonstration of the skill in Lab. CLINICAL INSTRUCTION: Instructor to initial and date the successful performance of each skill at Clinical. REMINDER: No student shall perform any skill at Clinical unless the instructor has first trained and found that student to be proficient in performing the skill in the laboratory/simulation setting. INSTRUCTOR NAME AND INITIAL

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3. 4. CLINICAL FACILITY NAME

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3. 4. NURSE AIDE SKILLS TASK/SKILL

INFECTION CONTROL PROCEDURES - Handwashing* - Don/Doff gown and gloves* SKIN CARE - Back rub - Decubitus Prevention - Identifies/Reports changes to skin - Foot Care* PERSONAL CARES - Bed Bath (full/partial)* - Tub Bath - Shower - Shampooing Client hair (shower/bed) - Shaving with safety razor - Shaving with electric razor - Fingernail care (clean/file)* - Perineal Care (male) - Perineal Care (female)* DRESSING - Assist to Dress (affected side)* - Assist to Dress using assistive devices - Cues confused Client to dress self

DATE & INITIAL SKILL PERFORMED SATISFACTORILY LAB CLINICAL

CLINICAL INSTRUCTOR COMMENTS

NAME OF STUDENT NURSE AIDE:_________________________________________ TASK/SKILL

DRESSING (continued) - Dressing Client with an I.V. - Provides total assistance with dressing - Assist with glasses - Assist with hearing aid - Assist with toiletries (perfume, makeup) - Applies antiembolitic stocking (TED hose)* ORAL HYGIENE - Mouth Care/Brush Client’s Teeth* - Denture Care* - Mouth Care of Unconscious Client AMBULATION - Walker - Cane - Gait Belt* TRANSFER TECHNIQUES - Bed to Wheel Chair (with transfer belt)* - Two Person Transfers - Non-weight Bearing - Mechanical Lift Use POSITIONING & TURNING - Supine in Bed - Side-lying (Lateral) in Bed* - Prone in Bed - Fowler’s Position - Sim’s Position - Use of lift sheet - Logrolling - Dangling - Repositioning in a chair VITAL SIGNS & BASIC NURSING - Measure & Record Blood Pressure* - Measure & Record Respirations* - Measure & Record Radial Pulse* - Measure & Record Apical Pulse - Measure & Record Brachial Pulse - Measure & Record Oral Temperature - Measure & Record Axillary Temp - Measure & Record Tympanic Temp - Measure & Record Height - Measure & Record Weight* - Reports abnormal vital sign(s) to nurse

DATE& INITIAL SKILL PERFORMED SATISFACTORILY LAB CLINICAL

CLINICAL INSTRUCTOR COMMENTS

NAME OF STUDENT NURSE AIDE:_________________________________________ TASK/SKILL

RANGE OF MOTION - Ankle/Wrist (passive/active)* - Knee/ Elbow (passive/active)* - Shoulder (passive/active)* - Hip (passive/active) - Hand/Fingers (passive/active) NUTRITION & HYDRATION - Feed dependent Client* - Cue confused Client to feed self - Use of assistive devices for feeding - Thickened Liquids - Abdominal Thrusts (Heimlich) - Measure & Record Intake (fluid) - Measure & Record Intake (food) TOILETING/ELIMINATION - Measure & Record Output* - Bedpan* - Urinal - Bedside Commode - Indwelling Catheter Care (male) - Indwelling Catheter Care (female)* - External Catheter - Suprapubic Catheter - Empty Catheter Bag - Empty Ostomy Bag - Bowel & Bladder Retraining RESTRAINTS & ALTERNATIVES - Side Rails - Lap Buddy - Tab Alarm - Pressure Alarm CARE OF CLIENT UNIT - Makes Unoccupied Bed - Makes Occupied Bed* - Maintains clean, safe Client unit - Cares for and secures Client possessions RESTORATIVE CARE - Assist Client with Prosthetic Device - Assist Client with Orthotic Device DEATH & DYING - Provides post-mortem cares - Allows dying client to express fears or beliefs

DATE& INITIAL SKILL PERFORMED SATISFACTORILY LAB CLINICAL

CLINICAL INSTRUCTOR COMMENTS

NAME OF STUDENT NURSE AIDE:_________________________________________ TASK/SKILL

COMMUNICATION - Appropriate Verbal Communication - Appropriate Nonverbal Communication - Assists in resolving grievances & disputes - Provides privacy & maintains confidentiality - Responds Appropriately to Client Behavior - Communicates appropriately with cognitively impaired Clients SAFETY & EMERGENCY - Recognizes & reports safety hazards - Recognizes & reports emergencies and responds appropriately - RACE/PASS** (Fire Safety) - Safely handles O2 MENTAL HEALTH & SOCIAL SERVICE NEEDS - Modifies own behavior in response Client behavior - Provides emotional support to Client - Encourages family support of Client - Recognizes & responds developmental tasks of aging - Encourages Client to make personal choices consistent with Client’s dignity and needs - Promotes Client’s ability to function independently - Assists Client to attend and participate in activities of Client’s choice OBSERVATIONAL/DOCUMENTATION SKILLS - Observes, documents and reports any abnormal changes to any system of the body to supervisor - Observes Clients for signs of abuse, neglect, mistreatment and reports any such signs to supervisor

DATE& INITIAL SKILL PERFORMED SATISFACTORILY LAB CLINICAL

CLINICAL INSTRUCTOR COMMENTS

NAME OF STUDENT NURSE AIDE:_________________________________________ TASK/SKILL

DATE& INITIAL SKILL PERFORMED SATISFACTORILY LAB CLINICAL

CLINICAL INSTRUCTOR COMMENTS

CARE OF THE COGNITIVELY IMPAIRED - Employs standard techniques to care for cognitively impaired - Demonstrates understanding of behavior of the cognitively impaired - Responds appropriately to behavior of the cognitively impaired - Employs standard methods to reduce the effects of cognitive impairment * Denotes a practical skill that is part of the current State Competency Evaluation. ** RACE – Rescue, Activate or Alert, Confine or Contain, Extinguish PASS – Pull, Aim, Squeeze, Sweep

Terminal Competency Evaluation All students completing the nurse aide training program are expected to demonstrate, at minimum, the six Terminal Competencies listed below. Please evaluate the student’s success affecting the Terminal Competencies when interacting with Clients during the clinical experience. 1= Needs Improvement – The student seldom or never meets the objective. 2= Meets the Standard – The student frequently or often meets the objective. 3= Exceeds the Standard – The student consistently or always meets the objective.

# Terminal Competency 1

The student demonstrates the ability to form relationships, communicate and interact competently on a one-to-one basis with clients. Introduces self to Client; Explains procedure; Maintains professional communication; Speaks or communicates so Client can understand; Ensures call light is within reach before exiting room

2

The student demonstrates sensitivity to Clients' emotional, social, and mental health needs through skillful, directed interactions. Responds appropriately to Client behavior; Allows Client time to express feelings or concerns

3

The student demonstrates the ability to assist Clients in attaining and maintaining independence. Encourages and offers Client choices; Encourages Client to perform self-care; Demonstrates to Client the correct use of adaptive devices

4

The student exhibits behavior in support and promotion of Clients' rights. Knocks and waits for permission to enter Client room; Answers call lights and provides care promptly; Maintains confidentiality of records; Provides privacy during cares

5

The student demonstrates observational and documentation skills needed in the assessment of Clients' health, physical condition and well-being. Observes Client for abnormalities or changes; Reports abnormalities or changes to Nurse; Documents vital signs, intake and output, height and weight correctly

6

The student demonstrates an awareness of the Colorado Nurse Aide Practice Act (NAPA) Provides cares/services according to care plan; Provides the cares/services for which he/she has been trained and found proficient; Verbalizes understating of NAPA’s function

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